Wine Club Membership Change Form

* First Name:
* Last Name:
* Email Address:
Company:

Phone Information

* Day:
Mobile:
Evening:

Billing Address

Address:
City:
State:
Zipcode:

Shipping Address

Check Here if Same as Billing.
Address:
City:
State:
Zipcode:

Change Membership Type

To change your membership type, please select one of these options:

Change Delivery Status

To change delivery status, please select one of these options:

Change Credit Card Information

Check Here if you would like to change your credit card on file, and your Wine Club Concierge will contact you for the new card number.

Or, you can easily update your credit card information by logging into your Online Store account here.

Cancel Membership

Check Here to Cancel Membership.
* Please tell us why you would like to cancel:

Request a Call Back

Check Here if you would like your Wine Club Concierge to call you for any reason.

Preferred Contact Information

Best number to reach you:
Best time to call:

Questions/Comments

Please enter any other comments here: